MAYO CLINIC: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
MAYO CLINIC (EIN 41-1906820)
Tax period
2015-01-01 to 2015-12-31
Filed
2016-11-11
IRS object ID
201603169349304055
Schema version
2015v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2016-11-11T14:45:44-06:00ReturnTs
Tax Period End2015-12-31TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2015-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN411906820EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MAYO CLINIC HEALTH SYSTEM-LAKE CITYBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMAYOBusinessNameControlTxt
Phone5075381297PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1500 WEST GRANT STREETAddressLine1Txt
CityLAKE CITYCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55041ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJAMES J TARASOVITCHPersonNm
Person TitleREGION CFOPersonTitleTxt
Phone5073852646PhoneNum
Signature2016-11-11SignatureDt
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerDAVID C AGERTER MDPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1500 WEST GRANT STREETAddressLine1Txt
CityLAKE CITYCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55041ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$42,668,508GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Group Exemption5983GroupExemptionNum
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.MAYOCLINICHEALTHSYSTEM.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1998FormationYr
Legal Domicile StateMNLegalDomicileStateCd
Activity Or MissionOPERATION OF A HOSPITAL, FOUR CLINICS AND A NURSING HOME.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent4VotingMembersIndependentCnt
Total Employee304TotalEmployeeCnt
Total Volunteers106TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$453,408PYContributionsGrantsAmt
CY Contributions Grants$232,711CYContributionsGrantsAmt
PY Program Service Revenue$45,891,970PYProgramServiceRevenueAmt
CY Program Service Revenue$42,265,887CYProgramServiceRevenueAmt
PY Investment Income$90,723PYInvestmentIncomeAmt
CY Investment Income$1,725CYInvestmentIncomeAmt
PY Other Revenue$141,166PYOtherRevenueAmt
CY Other Revenue$159,275CYOtherRevenueAmt
PY Total Revenue$46,577,267PYTotalRevenueAmt
CY Total Revenue$42,659,598CYTotalRevenueAmt
PY Grants And Similar Paid$9,718PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$6,299CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$17,424,644PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$18,390,156CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$24,773,339PYOtherExpensesAmt
CY Other Expenses$24,152,707CYOtherExpensesAmt
PY Total Expenses$42,207,701PYTotalExpensesAmt
CY Total Expenses$42,549,162CYTotalExpensesAmt
PY Revenues Less Expenses$4,369,566PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$110,436CYRevenuesLessExpensesAmt
Total Assets BOY$34,755,493TotalAssetsBOYAmt
Total Assets EOY$39,703,752TotalAssetsEOYAmt
Total Liabilities BOY$4,100,894TotalLiabilitiesBOYAmt
Total Liabilities EOY$8,938,718TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$30,654,599NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$30,765,034NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTO INSPIRE HOPE AND CONTRIBUTE TO HEALTH AND WELL-BEING BY PROVIDING THE BEST CARE TO EVERY PATIENT THROUGH INTEGRATED CLINICAL PRACTICE, EDUCATION, AND RESEARCH.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$36,719,535ExpenseAmt
Revenue$42,385,426RevenueAmt
DescPATIENT CARE (SEE SCHEDULE O):PATIENT CARE:MAYO CLINIC HEALTH SYSTEM - LAKE CITY (MCHS-LAKE CITY) IS A MEMBER OF THE MAYO CLINIC HEALTH SYSTEM. MAYO CLINIC HEALTH SYSTEM IS A FAMILY OF CLINICS, HOSPITALS AND HEALTH CARE FACILITIES SERVING COMMUNITIES IN MINNESOTA, IOWA, WISCONSIN AND GEORGIA. AS PART OF MAYO CLINIC, THE HEALTH SYSTEM OFFERS CARE DESIGNED FOR THE WHOLE BODY CLOSE TO THE PATIENT'S HOME, WHEN THEY NEED IT. A MULTIDISCIPLINARY TEAM OF EXPERTS HAS READY ACCESS TO KNOWLEDGE, RESOURCES, AND EXPERTISE OF MAYO CLINIC AND COLLABORATES ON PROVIDING EXACTLY THE CARE THE PATIENT NEEDS. MAYO CLINIC HEALTH SYSTEM SITES EMPLOY APPROXIMATELY 1,000 PHYSICIANS AND 15,000 ALLIED HEALTH STAFF. IN ADDITION, MAYO CLINIC PHYSICIANS FROM MULTIPLE SPECIALTIES REGULARLY SEE PATIENTS AT HEALTH SYSTEM FACILITIES. BESIDES HAVING HEALTH CARE FACILITIES IN MORE THAN 60 COMMUNITIES, MAYO CLINIC HEALTH SYSTEM INCLUDES 19 OWNED HOSPITALS, TWO OWNED NURSING HOMES, PHYSICIAN SERVICE AGREEMENTS WITH ONE ADDITIONAL HOSPITAL, AND CONTRACT MANAGEMENT AGREEMENTS WITH TWO ADDITIONAL HOSPITALS AND ONE NURSING HOME.SINCE ITS INCEPTION IN 1992, MAYO CLINIC HEALTH SYSTEM HAS GROWN INTO ONE OF THE MOST SUCCESSFUL REGIONAL HEALTH CARE SYSTEMS IN THE UNITED STATES. MORE THAN 600,000 UNIQUE PATIENTS ACCOUNT FOR MORE THAN 2.6 MILLION VISITS ANNUALLY IN MAYO CLINIC HEALTH SYSTEM. IT IS ALSO A NATIONAL LEADER IN QUALITY AND SAFETY EFFORTS.MCHS-LAKE CITY OWNS AND OPERATES AN 18 BED CRITICAL ACCESS HOSPITAL SERVING LAKE CITY, MINNESOTA AND SURROUNDING COMMUNITIES. DURING THE YEAR ENDED DECEMBER 31, 2015, LAKE CITY HAD 198 MEDICAL/SURGICAL ADMISSIONS, 16 OBSTETRIC ADMISSIONS, AND 171 SWING BED ADMISSIONS WITH AN AVERAGE DAILY CENSUS OF 7.9. IN ADDITION, THERE WERE 2,522 EMERGENCY ROOM VISITS, 204 SAME DAY SURGERIES AND ANCILLARY SERVICES INCLUDING LABORATORY, CARDIAC REHABILITATION, PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY, AND RADIOLOGY SERVICES. RADIOLOGY SERVICES INCLUDED MAMMOGRAPHY, CT, MRI AND ULTRASOUND.MCHS-LAKE CITY ALSO OWNS AND OPERATES FOUR CLINICS LOCATED IN ALMA, WISCONSIN AND IN LAKE CITY, PLAINVIEW AND WABASHA, MINNESOTA. THESE CLINICS ARE STAFFED BY ELEVEN FAMILY MEDICINE PHYSICIANS, A GENERAL SURGEON, TWO PHYSICIAN ASSISTANTS, AND FIVE NURSE PRACTITIONERS, INCLUDING A CERTIFIED NURSE-MIDWIFE. ON AN ANNUAL BASIS, THERE ARE APPROXIMATELY 52,379 PATIENT VISITS AMONG THE FOUR CLINIC LOCATIONS.MCHS-LAKE CITY CONTINUES TO PROVIDE A VENTILATOR PROGRAM TO ENSURE CONTINUUM OF CARE AND THE MOST APPROPRIATE PLACEMENT AND LEVEL OF CARE FOR VENTILATED AND OTHER PATIENTS REQUIRING A HIGH LEVEL OF RESPIRATORY CARE. MCHS-LAKE CITY HAS COMMITTED ELEVEN BEDS IN THE FACILITY FOR CARING FOR THIS KIND OF PATIENT POPULATION, ALONG WITH PROVIDING CLASSROOM AND SKILLS TRAINING FOR NURSING STAFF AND PROVIDERS.MCHS-LAKE CITY PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FINANCIAL ASSISTANCE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. SERVICES ARE ALSO PROVIDED TO MEDICAID AND MEDICARE PATIENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. IN 2015, MCHS-LAKE CITY PROVIDED APPROXIMATELY $761,500 IN FINANCIAL ASSISTANCE TO PATIENTS. THE TOTAL COST OF UNCOMPENSATED CARE PROVIDED TO LOW INCOME PATIENTS THROUGH MEDICAID AND MINNESOTACARE (A STATE PROGRAM FOR PROVIDING MEDICAL CARE TO THE LOW INCOME POPULATION) WAS APPROXIMATELY $1,952,200 WHICH INCLUDES THE MEDICAID SURCHARGE OF $431,177 AND MNCARE TAX OF $326,313.THE UNREIMBURSED COST OF SERVICES TO MEDICARE PATIENTS WAS APPROXIMATELY $291,000. LAKE CITY HAS APPROXIMATELY 106 VOLUNTEERS INCLUDING INDIVIDUALS AND SERVICE GROUPS WHO PROVIDED APPROXIMATELY 3,101 HOURS OF VOLUNTEER SERVICES DURING 2015. THEY STAFF THE INFORMATION DESK DIRECTING PATIENTS AND VISITORS TO THEIR DESTINATION AND PERFORM CLERICAL DUTIES FOR VARIOUS DEPARTMENTS IN THE MEDICAL CENTER. BASED ON THE 2015 INDEPENDENT SECTOR STATISTICS, THE APPROXIMATE VALUE OF THESE SERVICES IS $73,060.MAYO CLINIC HEALTH SYSTEM-LAKE CITY PROVIDES SUPPORT SERVICES TO AFFILIATED ORGANIZATIONS TO HELP FURTHER THEIR EXEMPT PURPOSE OF PROVIDING PATIENT CARE.MAYO CLINIC HEALTH SYSTEM - LAKE CITY (MCHS-LAKE CITY) ALSO OWNS AND OPERATES A 90-BED NURSING HOME THAT SEEKS TO ENHANCE RESIDENT'S QUALITY OF LIFE BY HELPING INDIVIDUALS MAINTAIN THEIR HEALTH AND SELF-RELIANCE. RESIDENTS ARE PROVIDED WITH 24-HOUR NURSING CARE, A ROOM, NUTRITIONALLY WELL-BALANCED MEALS, SNACKS, HOUSEKEEPING AND LAUNDRY SERVICES, ACTIVITY PROGRAMS, AND SOCIAL SERVICES ASSISTANCE AS NEEDED OR REQUESTED. RESIDENTS ALSO HAVE ACCESS TO SPECIALIZED SERVICES SUCH AS REHABILITATION SERVICES, REGISTERED DIETICIAN SERVICES, BEAUTY AND BARBER SERVICES, TELEPHONE SERVICES AND TELEVISION/CABLE SERVICES FOR AN ADDITIONAL FEE. THE AVERAGE DAILY CENSUS FOR THE NURSING HOME IN 2015 WAS 83.96.THE NURSING HOME'S DIETARY DEPARTMENT PROVIDES MEALS ON A DAILY BASIS FOR THE LAKE CITY HOME DELIVERED MEALS PROGRAM. MEALS ARE DELIVERED BY LIONS CLUB VOLUNTEERS TO LAKE CITY RESIDENTS WHO HAVE BEEN REFERRED TO THE PROGRAM BY HEALTHCARE PROVIDERS. MCHS-LAKE CITY PROVIDES THE ADMINISTRATION FOR THE PROGRAM INCLUDING REGISTRATION, NUTRITION PLANNING, MEAL PREPARATION, AND BILLING. THIS SERVICE ALLOWS SENIOR CITIZENS AND OTHERS WITH MEDICAL NEEDS TO LIVE INDEPENDENTLY FOR LONGER THAN WOULD OTHERWISE BE POSSIBLE.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$108,977ExpenseAmt
Grant$6,299GrantAmt
Revenue$650RevenueAmt
DescCOMMUNITY BENEFIT - SEE SCHEDULE O:AS PART OF ITS ACTIVITIES, MAYO CLINIC HEALTH SYSTEM - LAKE CITY (MCHS-LAKE CITY) PROVIDES VARIOUS SUPPORT GROUPS AND PROGRAMS TO THE COMMUNITY AT NO CHARGE. THESE GROUPS AND CLASSES INCLUDE CARDIAC SUPPORT GROUPS AND CARDIAC REHAB PHASE 3 / DIABETIC EDUCATIONAL PROGRAMS FOR 65 PARTICIPANTS AND COORDINATED TRAINING WITH CARDIAC REHAB STAFF FOR AN ADDITIONAL 32 PARTICIPANTS. OUTREACH FOR CITIZENS WHERE OUTREACH NURSES CONDUCTED BLOOD PRESSURE SCREENING FOR 995 AND BLOOD SUGAR SCREENING FOR 1,242 PERSONS, AND PROVIDED MENTORING PROGRAMS TO IMPROVE HEALTH. PRENATAL CLASSES FOR EXPECTANT PARENTS HAVE EXPANDED TO A BREAST FEEDING "BABY CAF" WHERE MOTHERS AND BABIES GATHER WITH LACTATION SPECIALISTS TO DEVELOP GOOD NUTRITION HABITS FOR BABIES AND YOUNG CHILDREN.MCHS-LAKE CITY OFFERED SPORTS PHYSICALS AT A REDUCED RATE FOR STUDENTS WHO ARE PARTICIPATING IN SPORTS THROUGH THE LOCAL SCHOOLS, A PREVENTATIVE INJURY TRAINING PROGRAM, YOGA TRAINING FOR 35 WRESTLERS, FREE SKIN SCREENINGS AT LOCAL WRESTLING MEETS, AND STAFF ATTENDANCE AT HOME HIGH SCHOOL FOOTBALL GAMES TO RESPOND TO EMERGENCIES AND COMMUNITY ATHLETIC TRAINING FOR 360 YOUTH. MCHS-LAKE CITY ALSO HAS A PROGRAM THAT ALLOWS LOCAL HIGH SCHOOL STUDENTS TO COME ON-SITE AND LEARN ABOUT HEALTHCARE-RELATED CAREERS AND PARTICIPATE IN JOB SHADOWING EXPERIENCES. 25 STUDENTS PARTICIPATED IN HEALTH CAREER CLASS PRESENTATIONS. MCHS-LAKE CITY STAFF PARTICIPATED IN THE BOOK READ "GOOD FOR YOU AND ME" PROMOTING THE 5-2-1-0 NUTRITION AND ACTIVITY PROGRAM WITH PRIMARY CARE AND PEDIATRIC STAFF. MCHS LAKE CITY SUPPORTS THE BIKE PROGRAM IN THE ELEMENTARY SCHOOL, TRAIN DEVELOPMENT IN THE COUNTY AND COMMUNITY BIKE AND RUNNING EVENTS. ALSO DURING 2015, MCHS-LAKE CITY PROVIDED $1,500 OF SUPPORT FOR A FAMILY AFFECTED BY THE ILLNESS OF A CHILD AND $5,359 IN DONATIONS TO LOCAL CHARITIES OR COMMUNITY ORGANIZATIONS. MAYO CLINIC HEALTH SYSTEM - LAKE CITY (MCHS-LAKE CITY) EMPLOYEES THROUGHOUT THE ORGANIZATION ASSESS THE NEEDS OF LAKE CITY AND THE SURROUNDING COMMUNITIES THROUGH PERSONAL INTERACTION AND INVOLVEMENT WITH LOCAL SCHOOLS, CIVIC GROUPS AND HEALTH DEPARTMENTS, AS WELL AS THROUGH THE COLLECTION AND ANALYSIS OF FEEDBACK FROM PATIENTS AND COMMUNITY MEMBERS.MCHS-LAKE CITY EMPLOYEES ARE ALSO STRONGLY CONNECTED WITH LOCAL CIVIC GROUPS. MANY EMPLOYEES ARE ACTIVE MEMBERS OF VARIOUS LAKE CITY ORGANIZATIONS, WHILE OTHERS GIVE HEALTHCARE PRESENTATIONS TO THESE GROUPS. THIS PARTICIPATION NOT ONLY PROMOTES INVOLVEMENT IN THE COMMUNITY, BUT ALSO GIVES COMMUNITY MEMBERS A CHANCE TO ASK QUESTIONS, SHARE COMMENTS, CONCERNS OR OTHER SUGGESTIONS THEY MAY HAVE REGARDING THE MEDICAL CENTER. MCHS-LAKE CITY PROVIDES PREVENTIVE HEALTH SCREENINGS THROUGHOUT THE COMMUNITY. MCHS-LAKE CITY ALSO WORKS WITH THE WABASHA PUBLIC HEALTH ORGANIZATION TO DEVELOP RELATIONSHIPS AMONG HEALTH CARE PROVIDERS AND COMMUNITY LEADERS. THIS PARTNERSHIP PROMOTES THE ACTIVE REFERRAL OF PATIENTS TO LOCAL RESOURCES SUCH AS ACCESS TO HIGH QUALITY NUTRITIOUS FOODS, PHYSICAL ACTIVITY AND TOBACCO USE CESSATION PROGRAMS.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$36,828,512TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit CounselingYes (1)CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (1)ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (1)BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (1)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee304EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member4IndependentVotingMemberCnt
Family Or Business RlnYes (1)FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of Committees0MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local ChaptersYes (1)LocalChaptersInd
Policies Reference ChaptersYes (1)PoliciesReferenceChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldMNStatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is FldWIStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CORPORATE TAX UNITBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone5075381297PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1200 FIRST STREET SWAddressLine1Txt
CityROCHESTERCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55905ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
AGERTER MD DAVID C
DIRECTOR/REGION CEO1.0040.00Yes (X)Yes (X)$0$597,592$26,206
BECKMAN JOEL
DIRECTOR1.000.00Yes (X)$0$0$0
GRUBER JOHN
DIRECTOR1.000.00Yes (X)$0$0$0
MAHN DAVID
DIRECTOR1.000.00Yes (X)$0$0$0
SCHAAL MELISSA
DIRECTOR1.000.00Yes (X)$0$0$0
SOLBERG MD JEREMY J
DIRECTOR40.000.00Yes (X)$242,696$0$46,808
SPANO MD DENNIS C
DIRECTOR/VICE CHAIR40.000.00Yes (X)Yes (X)$518,187$0$56,835
WILKINSON MD JOHN M
DIRECTOR1.0040.00Yes (X)$0$255,690$25,499
WITT MD THOMAS J
DIRECTOR/CHAIR40.000.00Yes (X)Yes (X)$474,073$0$69,829
GUDGELL STEPHEN F
RIVER CORRIDOR CAO1.0040.00Yes (X)$0$203,028$24,335
KOCH MARK B
ASS'T SECRETARY1.0040.00Yes (X)$0$483,196$23,677
PARKS DOUGLAS A
REGION CAO1.0040.00Yes (X)$0$239,099$50,017
STIENE SUSAN M
SECRETARY40.000.00Yes (X)$168,264$0$43,782
TARASOVITCH JAMES J
REGION CFO1.0040.00Yes (X)$0$309,144$66,950
ADAMSON MD STEVEN C
PHYSICIAN40.000.00$331,570$0$55,789Yes (X)
ANDERSON DO TRENT D
PHYSICIAN40.000.00$247,463$0$41,218Yes (X)
FOSS MD RANDY M
PHYSICIAN40.000.00$260,757$0$26,994Yes (X)
RENELT MD JOHN A
PHYSICIAN40.000.00$396,419$0$61,846Yes (X)
SCHWEND DO PHILLIP P
PHYSICIAN40.000.00$331,144$0$61,207Yes (X)
BROWN MARK C
FORMER OFFICER0.0040.00$0$156,380$39,185Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,970,573TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$2,244,129TotReportableCompRltdOrgAmt
Total Other Compensation$720,177TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K31IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (1)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
EBENEZER MANAGEMENT SERVICES INC
2722 PARK AVENUEMINNEAPOLISMN55407MANAGEMENT SERVICES$2,781,952
MAYO FND FOR MEDICAL EDUCATION AND RESEA
200 FIRST STREET SWROCHESTERMN55905PURCHASING AGENT$1,725,718
MAYO CLINIC HEALTH SYSTEM-ALBERT LEA AND
1000 FIRST DRIVE NWAUSTINMN55912SUPPORT SERVICES$1,418,244
MAYO CLINIC
200 FIRST STREET SWROCHESTERMN55905MEDICAL & SUPPORT SERVICES$682,349
CENTREX REHAB
8120 PENN AVENUE SOUTH 227BLOOMINGTONMN55431MEDICAL SERVICES$248,985
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K9CntrctRcvdGreaterThan100KCnt
Membership Dues$1,010MembershipDuesAmt
Related Organizations$96,074RelatedOrganizationsAmt
Government Grants$135,557GovernmentGrantsAmt
All Other Contributions$70AllOtherContributionsAmt
Total Contributions$232,711TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT REVENUE620000$41,662,594$41,662,594
SHARED SERVICES REVENU561000$602,517$602,517
LIFELINE621990$776$776
FieldValueIRS element (for citing)
Total Program Service Revenue$42,265,887TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,725TotalRevenueColumnAmt
Exclusion$1,725ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$39,842RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$7,812RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$32,030RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$32,030TotalRevenueColumnAmt
Exclusion$32,030ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$8,154FundraisingGrossIncomeAmt
Fundraising Direct Expenses$1,098FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$7,056TotalRevenueColumnAmt
Exclusion$7,056ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
CAFETERIA/VENDING722210$110,033$110,033
MISC. REVENUE900099$10,107$10,107
MEDICAL RECORD/TRANSCR541900$49$49
FieldValueIRS element (for citing)
Other Revenue Total$120,189OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$42,659,598TotalRevenueColumnAmt
Related Or Exempt Func Income$42,386,076RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$40,811ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$4,799TotalAmt
Program Services$4,799ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$1,500TotalAmt
Program Services$1,500ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,620,474TotalAmt
Program Services$1,234,267ProgramServicesAmt
Management And General$386,207ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$105,143TotalAmt
Program Services$105,143ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$13,007,764TotalAmt
Program Services$12,030,362ProgramServicesAmt
Management And General$977,402ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$1,130,152TotalAmt
Program Services$1,045,232ProgramServicesAmt
Management And General$84,920ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,596,564TotalAmt
Program Services$1,476,737ProgramServicesAmt
Management And General$119,827ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$930,059TotalAmt
Program Services$860,174ProgramServicesAmt
Management And General$69,885ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$1,879TotalAmt
Program Services$1,879ProgramServicesAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$346TotalAmt
Program Services$346ProgramServicesAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$14,985,064TotalAmt
Program Services$11,957,936ProgramServicesAmt
Management And General$3,027,128ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$982TotalAmt
Program Services$580ProgramServicesAmt
Management And General$402ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,400,429TotalAmt
Program Services$969,540ProgramServicesAmt
Management And General$430,889ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$1,650TotalAmt
Program Services$750ProgramServicesAmt
Management And General$900ManagementAndGeneralAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$592TotalAmt
Program Services$592ProgramServicesAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$2,122,028TotalAmt
Program Services$1,964,755ProgramServicesAmt
Management And General$157,273ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$276,731TotalAmt
Program Services$172,337ProgramServicesAmt
Management And General$104,394ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$299TotalAmt
Management And General$299ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$782,909TotalAmt
Program Services$716,400ProgramServicesAmt
Management And General$66,509ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$250,975TotalAmt
Management And General$250,975ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
MEDICAL SUPPLIES$3,010,771$3,010,771
BAD DEBT EXPENSE$484,748$484,748
MEDICAID SURCHARGE$431,177$431,177
MN CARE TAX$326,313$326,313

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$75,814TotalAmt
Program Services$32,174ProgramServicesAmt
Management And General$43,640ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$42,549,162TotalAmt
Program Services$36,828,512ProgramServicesAmt
Management And General$5,720,650ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$99,343BOYAmt
EOY$374,481EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$20,341BOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$7,074,944BOYAmt
EOY$7,230,284EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$5,000BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$543,455BOYAmt
EOY$253,142EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$246,314BOYAmt
EOY$51,255EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$23,221,947LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$12,263,584LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$11,266,594BOYAmt
EOY$10,958,363EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$15,499,502BOYAmt
EOY$19,763,185EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$1,073,042EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$34,755,493BOYAmt
EOY$39,703,752EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$3,124,630BOYAmt
EOY$3,740,580EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$20,338BOYAmt
EOY$29,902EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$955,926BOYAmt
EOY$5,168,236EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$4,100,894BOYAmt
EOY$8,938,718EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$30,654,599BOYAmt
EOY$30,113,061EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
EOY$651,973EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$30,654,599BOYAmt
EOY$30,765,034EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$34,755,493BOYAmt
EOY$39,703,752EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$110,436ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact Legislators0DirectContactLegislatorsInd
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$346OtherActivitiesAmt
Total Lobbying Expenditures$346TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1:FormAndLineReferenceDesc
ExplanationTHE AMOUNT IN "OTHER ACTIVITIES" REPRESENTS A PORTION OF PROFESSIONAL DUES ATTRIBUTABLE TO LOBBYING. MAYO CLINIC HEALTH SYSTEM-LAKE CITY PROVIDES INFORMATION OR EXPRESSES ITS CONCERNS TO LEGISLATIVE BODIES AND GOVERNMENT OFFICIALS ON MATTERS DIRECTLY RELATED TO HEALTH, THE DELIVERY OF HEALTH CARE AND MEDICAL EDUCATION AND/OR RESEARCH. IN 2015, MCHS-LAKE CITY REPRESENTATIVES HAD A MEETING WITH MEMBERS OF THE LEGISLATIVE AND EXECUTIVE BRANCHES OF GOVERNMENT TO DISCUSS ISSUES RELATING TO HEALTH CARE AND HEALTH CARE REFORM.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtcInd
Incl Escrow Custodial Acct LiabYes (1)InclEscrowCustodialAcctLiabInd
Explanation ProvidedYes (X)ExplanationProvidedInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$101,866OtherCostOrOtherBasisAmt
Book Value$101,866BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$3,775InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis$16,217,799OtherCostOrOtherBasisAmt
Depreciation$7,623,374DepreciationAmt
Book Value$8,598,200BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,016,948OtherCostOrOtherBasisAmt
Depreciation$4,607,865DepreciationAmt
Book Value$1,409,083BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$881,559OtherCostOrOtherBasisAmt
Depreciation$32,345DepreciationAmt
Book Value$849,214BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$10,958,363TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp

FieldValueIRS element (for citing)
DescMAYO POOLED INVESTMENTSDesc
Book Value$19,763,185BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$19,763,185TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
DUE TO AFFILIATES$5,003,139
DEFERRED COMPENSATION LIABILITY$165,097
FieldValueIRS element (for citing)
Total Liability$5,168,236TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART IV, LINE 2B:NURSING HOME RESIDENT TRUST ACCOUNT - RESIDENT FUNDS.
PART X, LINE 2:AT DECEMBER 31, 2015 AND 2014, THE RESERVE FOR UNRECOGNIZED TAX BENEFITS WAS NOT SIGNIFICANT, AND AS A RESULT, THERE IS NO RESERVE FOR UNRECOGNIZED TAX BENEFITS RECORDED FOR THE FILING ORGANIZATION.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent400Yes (X)Percent400Ind
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance Budget0FinancialAssistanceBudgetInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$761,450TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$761,450NetCommunityBenefitExpnsAmt
Total Expense0.01810TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,225,445TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$3,273,243DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,952,202NetCommunityBenefitExpnsAmt
Total Expense0.04640TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,986,895TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$3,273,243DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,713,652NetCommunityBenefitExpnsAmt
Total Expense0.06450TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$34,135TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$650DirectOffsettingRevenueAmt
Net Community Benefit Expns$33,485NetCommunityBenefitExpnsAmt
Total Expense0.00080TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$57,894TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$57,894NetCommunityBenefitExpnsAmt
Total Expense0.00140TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,127,929TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,955,024DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,172,905NetCommunityBenefitExpnsAmt
Total Expense0.02790TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$11,216TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$11,216NetCommunityBenefitExpnsAmt
Total Expense0.00030TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,231,174TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,955,674DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,275,500NetCommunityBenefitExpnsAmt
Total Expense0.03040TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$10,218,069TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$6,228,917DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,989,152NetCommunityBenefitExpnsAmt
Total Expense0.09490TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,858TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$4,858NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Coalition Building CoalitionBuildingGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$749TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$749NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$125TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$125NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,732TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$5,732NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReportedInd
Bad Debt Expense$484,748BadDebtExpenseAmt
Reimbursed By Medicare$11,906,551ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$12,316,403CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$409,852MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MAYO CLINIC HEALTH SYSTEM - LAKE CITYBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1500 WEST GRANT STREETAddressLine1Txt
CityLAKE CITYCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55041ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.MAYOCLINICHEALTHSYSTEM.ORGWebsiteAddressTxt
State License20693StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1MAYO CLINIC HEALTH SYSTEM - LAKE CITYBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
CHNA Conducted13CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (1)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts0CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLMAYOCLINICHEALTHSYSTEM.ORG/ABOUT-USOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt13ImplementationStrategyAdptYr
Strategy Posted Website0StrategyPostedWebsiteInd
Strategy AttachedYes (1)StrategyAttachedInd
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care400.000000000000FPGFamilyIncmLmtDscntCarePct
Income Level CriteriaYes (X)IncomeLevelCriteriaInd
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Residency CriteriaYes (X)ResidencyCriteriaInd
Other CriteriaYes (X)OtherCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLMAYOCLINICHEALTHSYSTEM.ORGFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLMAYOCLINICHEALTHSYSTEM.ORGFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLMAYOCLINICHEALTHSYSTEM.ORGFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
FAP Notice DisplayedYes (X)FAPNoticeDisplayedInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Other Actions TakenYes (X)OtherActionsTakenInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Other Method UsedYes (X)OtherMethodUsedInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
MAYO CLINIC HEALTH SYSTEM - LAKE CITYPART V, SECTION B, LINE 5: INPUT WAS PROVIDED BY THE HEALTHY COMMUNITIES SUPERVISOR AND COMMUNITY HEALTH SPECIALIST OF THE PUBLIC HEALTH DIVISION OF GOODHUE COUNTY HEALTH AND HUMAN SERVICES AND THE DIRECTOR OF WABASHA COUNTY PUBLIC HEALTH. IN ADDITION, INPUT WAS RECEIVED FROM KEY INFORMANT INTERVIEWS, COUNTY-WIDE MAIL SURVEYS, LOCAL FOCUS GROUPS, AND SURVEYS COMPLETED BY THE SCHOOL DISTRICTS, AND THE CHEMICAL HEALTH INITIATIVE.
MAYO CLINIC HEALTH SYSTEM - LAKE CITYPART V, SECTION B, LINE 6A: MAYO CLINIC HEALTH SYSTEM-CANNON FALLS, MAYO CLINIC HEALTH SYSTEM-LAKE CITY AND MAYO CLINIC HEALTH SYSTEM-RED WING COLLABORATED ON THE CHNA WHICH ENCOMPASSES THE COUNTIES THAT THE THREE HOSPITALS SERVE.
MAYO CLINIC HEALTH SYSTEM - LAKE CITYPART V, SECTION B, LINE 11: MAYO CLINIC HEALTH SYSTEM IN CANNON FALLS, LAKE CITY, AND RED WING (MCHS-CANNON FALLS/LAKE CITY/RED WING) COLLABORATED ON A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS, IDENTIFIED COMMON NEEDS, AND DEVELOPED THE FOLLOWING JOINT IMPLEMENTATION PLANS TO ADDRESS THE NEEDS IDENTIFIED IN THE ASSESSMENT.IDENTIFIED NEED: OBESITYGOAL: INCREASE AWARENESS OF INDIVIDUAL HEALTH AND OBESITY MANAGEMENT OPTIONS FOR YOUTH AND FAMILIES.SOCIAL MEDIA STRATEGY - LAKE CITY UTILIZED SOCIAL MEDIA TO PROMOTE THE MAYO MESSAGES FOR HEALTHY ACTIVITY AND NUTRITION. PINS AND POSTS THAT FOLLOW TRENDS AND HEALTH EVENTS ARE UPDATED DAILY. THE MEDIA TEAM CONTINUES TO WORK ON HOW TO QUANTIFY THE EFFECT THESE HEALTHY AND POSITIVE MESSAGES HAVE ON THE REGION. SOCIAL MEDIA ALLOWS VARIOUS DEMOGRAPHIC AUDIENCES THAT INCLUDE MALES AND FEMALES AGES 18-64 TO RECEIVE EDUCATION AND ENGAGE ONLINE WITH MAYO CLINIC HEALTH SYSTEM. MCHS SOCIAL MEDIA CHANNELS INCLUDE: FACEBOOK, TWITTER, YOUTUBE, PINTEREST AND GOOGLE PLUS. EXAMPLES OF STRATEGIC SOCIAL MEDIA CAMPAIGNS INCLUDE RUNNING TIPS, HEALTHY RECIPES, HEART HEALTH TIPS, EXERCISE, AND WELLNESS INFORMATION. WRITTEN CONTENT, PHOTOS AND VIDEOS ARE INCORPORATED AS APPLICABLE IN EACH SOCIAL MEDIA CHANNEL. BLOGS WRITTEN BY PROVIDERS INCORPORATE KEY WELLNESS MESSAGES AND REACH IS TRACKED BY THE NUMBER OF LIKES EACH RECEIVES. 5210 STRATEGY - THE 5210 PROGRAM HAS BEEN PROMOTED IN PEDIATRICS AND FAMILY PRACTICE THROUGH 5210 FLYERS AND "HEALTHY KIDS EAT WELL TO GROW STRONG" BOOKLET AT COMMUNITY EVENTS AND IN CLINIC VISITS. THE 5210 PROGRAM WAS PROMOTED IN A COMMUNITY BOOK READ THAT TOOK PLACE IN LOCAL DAY CARE HOMES AND CENTERS. THE MAYER MERCER BOOK, "GOOD FOR YOU AND ME" WAS READ TO CHILDREN, 5210 CARDS AND RIVER CITY KIDS FUN RUN INFORMATION WAS DISTRIBUTED. CHILDREN WERE INVITED TO BRING THEIR PARENTS TO THE PARK AND WALK WITH LOCAL PEDIATRICIANS ON MONDAYS IN JUNE AND JULY. THE FUN RUN ATTENDANCE INCREASED BY 2/3 TO 150 PARTICIPANTS AFTER THIS PROMOTION.MCHS-LAKE CITY - THE BLUFF VIEW ELEMENTARY PROGRAM IS A SPECIFIC PROGRAM TO REDUCE SCREEN TIME (TV, COMPUTER, IPAD AND GAMES) AND INCREASE EXERCISE AND ACTIVITY OF ELEMENTARY STUDENTS FOR ONE MONTH. 75% OF THE 660 STUDENTS PARTICIPATED AND BIKES WERE GIVEN AS REWARDS FOR THOSE WHO SUCCESSFULLY ELIMINATED EXCESS SCREEN TIME FROM THEIR DAY. COMMUNITY EVENT SPONSORSHIP AND PROGRAMMING - MCHS-LAKE CITY PARTNERED WITH LOCAL NONPROFITS TO ENCOURAGE HEALTHY LIVING COMMUNITY EVENTS INCLUDING BIKE RALLIES, RUN/WALKS, AND YOUTH ACTIVITIES SUCH AS THE LAKE CITY SCHOOL BIKE PROGRAM AND "GET READY TO RAMBLE". FREE EDUCATION AND SCREENINGS WERE GIVEN BY THE MCHS-LAKE CITY OUTREACH NURSES WHO HAD INDIVIDUAL CONTACT WITH 1,822 PERSONS. IN ORDER TO ROLE MODEL ACTIVITY, MINI FRISBEES ARE DISTRIBUTED RATHER THAN TREATS AT YOUTH EVENTS, BIKE HELMETS ARE USED AS GIVEAWAYS, AND COOKBOOKS WERE DISTRIBUTED WITH THE MAYO CLINIC GUIDE TO SELF-CARE. MCHS-LAKE CITY SPONSORS NUTRITIONAL EDUCATION AT COMMUNITY EVENTS AND MEETINGS, EMPHASIZING PLATE SIZE, NUTRITION NEEDS AND WEIGHT LOSS EDUCATION. CHILDHOOD OBESITY- LACTATION STAFF WORK WITH CHILDBIRTH EDUCATION (197 PARTICIPANTS IN BABY NUTRITION), THE BABY CAF (107 VISITS) AND THE BREAST FEEDING COALITION (COMMUNITY EDUCATION AND GOODHUE COUNTY FAIR BOOTH) TO PROVIDE ONGOING EDUCATION FOR NEW MOMS AND FAMILIES. PEDIATRIC STUDIES INDICATE BREAST FEEDING IS A FIRST STEP TO REDUCE OBESITY IN CHILDREN. LACTATION STAFF PRESENTED NUTRITION AND WEIGHT INFORMATION TO 120 PARTICIPANTS IN THE DAYCARE COALITION.IDENTIFIED NEED: ACCESSGOAL: TO SUPPORT AND PROMOTE COMMUNITY HEALTH CARE ACCESS.MCHS CANNON FALLS/LAKE CITY/RED WING PARTNERS WITH LOCAL VOLUNTEERS, COUNTY SERVICES, THE CARE FREE CLINIC BOARD OF DIRECTORS AND CARE CLINIC STAFF TO MAINTAIN THE FREE CLINIC FOR OUR SERVICE AREA. MALPRACTICE INSURANCE IS PROVIDED FOR ALL MCHS EMPLOYEES WHO VOLUNTEER AT THE CLINIC. THE CARE CLINIC IS LOCATED IN THE MCHS BUILDING THAT WAS PREVIOUSLY THE RED WING HOSPITAL EMERGENCY ROOM. TECHNOLOGY IS PROVIDED TO CONNECT THE VOLUNTEER PROVIDERS WITH THE PATIENT RECORDS AND TEST RESULTS WHILE MAINTAINING THE HIGHEST LEVEL OF PATIENT CONFIDENTIALITY. SPECIALTY SERVICES (DENTAL HEALTH, DERMATOLOGY, DIABETES, OPHTHALMOLOGY, ORTHOPEDICS, PODIATRY, WOMENS HEALTH) AT THE CLINIC ARE SUPPORTED WITH TIME AND EQUIPMENT. THE CARE CLINIC SERVED 693 UNIQUE PATIENTS WITH 1,158 ENCOUNTERS IN 2015. THE NURSE TRIAGE LINE PROMOTES ACCESS TO SERVICES FOR COMMUNITY MEMBERS WHETHER THEY ARE CURRENT OR NON-CURRENT PATIENTS. THE TRIAGE STAFF ARE ABLE TO DIRECT INDIVIDUALS WHO CALL ASKING FOR ADVICE TO APPROPRIATE LEVELS OF SERVICE AND MANY TIMES ARE ABLE TO SAVE THEM FROM AN APPOINTMENT BY PROVIDING OVER THE COUNTER OPTIONS. LIMITED PROTOCOLS CAN BE SHARED WITH NON PATIENTS INCREASING THEIR ACCESS TO CARE. THE QUANTITATIVE VALUE OF THIS SERVICE IS NOT TRACKED BY ZIP CODE AND VALUES CAN NOT BE ATTRIBUTED TO SPECIFIC EINS.IDENTIFIED NEED: MENTAL HEALTHGOAL: EDUCATE AND PROVIDE RESOURCES FOR THE COMMUNITY BY UTILIZING SOCIAL MEDIA TO EDUCATE THE COMMUNITY.DR. SOOD'S "GUIDE TO STRESS FREE LIVING" BOOK HAS HAD MULTIPLE FACEBOOK POSTS TO PROMOTE MENTAL HEALTH AND PERSONAL STRESS MANAGEMENT. DR. SOOD'S BOOK IS USED TO PROMOTE MENTAL HEALTH AT COMMUNITY EVENTS AND HIS BLOG IS SHARED ACROSS THE REGION. A COMMUNITY COLLABORATION LED BY MCHS CANNON FALLS/LAKE CITY/RED WING AND THE RED WING SHOE FOUNDATION SUCCEEDED IN MEETING THEIR THREE ESTABLISHED GOALS - 1) COUNTY WIDE RESOURCE LISTS WERE DEVELOPED AND SHARED, 2) NATIONAL ALLIANCE ON MENTAL ILLNESS (NAMI) CHAPTER WAS REINSTATED IN GOODHUE COUNTY, AND 3) ESTABLISHED THE "MAKE IT OK" ANTI STIGMA PROGRAM. "MAKE IT OK" HAS BECOME A COUNTY WIDE TRAINING PROGRAM FOR MENTAL HEALTH FIRST AID WITH TRAINING HELD AT THE COUNTY SCHOOL DISTRICTS. "MAKE IT OK" ANTI STIGMA EDUCATION CONTINUES AS A PARTNERSHIP WITH GOODHUE COUNTY HEALTH AND HUMAN SERVICES. MENTAL HEALTH CLINICAL SERVICES EXPANDED IN SOUTHEAST MINNESOTA BY BLENDING THE CMS COMPASS CARE COORDINATION MODEL INTO THE ADULT COMPLEX CARE COORDINATION MODEL TO IDENTIFY PEOPLE WITH MENTAL HEALTH ISSUES AT CLINIC VISITS FOR OTHER HEALTH ISSUES.THE COMPASS MODEL IS BUILT ON A REFERRAL PROCESS WHERE PATIENTS WITH CHRONIC DISEASE ARE IDENTIFIED, SCREENED AND REFERRED FOR MENTAL HEALTH CARE. AS THE PRIORITY HEALTH NEED IDENTIFIED, ADDRESSING MENTAL HEALTH IS CRUCIAL TO MAKING IMPROVEMENTS IN CHRONIC DISEASES OR OBESITY. BEGINNING IN 2015, ALL PATIENTS NEEDING CARE COORDINATION HAVE A PSYCHIATRIST ENGAGED IN THE CARE COORDINATION TEAM. TO FURTHER ASSIST WITH THE ENORMITY OF MENTAL HEALTH NEEDS IDENTIFIED IN THE 2013 CHNA AND TO INCREASE ACCESS TO CARE, NEW LICENSED SOCIAL WORKERS AND MENTAL HEALTH PROVIDERS WERE HIRED TO ACCOMMODATE PATIENT NEEDS.THE CARE CLINIC PARTNERSHIP RECEIVED A GRANT FOR A HISPANIC MENTAL HEALTH PROGRAM. THIS COUNTY WIDE BENEFIT HAS IMPACTED 230 PATIENTS IN 2015 WITH A BILINGUAL THERAPIST AND MCHS-RED WING'S INCREASED SPACE GIFT TO HISPANIC OUTREACH FOR THIS SERVICE. THIS IS IN ADDITION TO THE PSYCHOLOGY SERVICES OFFERED AT THE FREE CLINIC. NEEDS NOT BEING ADDRESSED: CHEMICAL HEALTH: A TEN YEAR GOVERNMENT GRANT CONCLUDED IN OCTOBER. THIS WORK FROM THE GOODHUE COUNTY FAMILY SERVICE COLLABORATIVE HAS MOVED INTO MENTAL HEALTH ASSESSMENT FOR THE COUNTY SCHOOL SYSTEM. TOBACCO: PROGRAMS ARE SUPPORTED IN THE COUNTY THROUGH HEALTH AND HUMAN SERVICES. MCHS DOES HAVE A CESSATION PROGRAM AND WORKS WITH OTHER STATE AND LOCAL REDUCTION EDUCATION PROGRAMS.
MAYO CLINIC HEALTH SYSTEM - LAKE CITYPART V, SECTION B, LINE 13B: IF A PATIENT BALANCE EXCEEDS 25% OF THE ANNUAL HOUSEHOLD INCOME, BUT THE PATIENT DOES NOT QUALIFY BASED ON FPG, CHARITY WILL BE ADJUSTED TO A MINIMUM OF THE AMOUNT GENERALLY BILLED (AGB). THE AGB IS DETERMINED USING THE LOOK-BACK METHOD AND CALCULATED USING ALL CLAIMS ALLOWED BY PRIVATE PAY INSURERS (INCLUDING MEDICARE ADVANTAGE) AND MEDICARE (TRADITIONAL) FOR INPATIENT AND OUTPATIENT SERVICES FOR THE YEAR.
MAYO CLINIC HEALTH SYSTEM - LAKE CITYPART V, SECTION B, LINE 13H: THE REGIONAL PROXIMITY OF A PATIENT'S RESIDENCY IS A FACTOR FOR PRESCHEDULED SERVICES ONLY AND SECONDARY TO MEDICAL NEED. REGIONAL PROXIMITY IS NOT A FACTOR FOR EMERGENCY CARE PROVIDED.
MAYO CLINIC HEALTH SYSTEM - LAKE CITYPART V, SECTION B, LINE 16I: WITH REGARD TO THE POSTINGS WITHIN THE HOSPITAL FACILITY, A BROCHURE IS MADE AVAILABLE IN NUMEROUS LOCATIONS THROUGHOUT THE FACILITY WHICH DESCRIBES THE FINANCIAL ASSISTANCE POLICY, HOW TO APPLY FOR FINANCIAL ASSISTANCE, AND GIVES THE INTERNET ADDRESS WHERE THE COMPLETE POLICY CAN BE OBTAINED.UPON ADMISSION, IF THE PATIENT DOES NOT HAVE INSURANCE OR EXPRESSES AN INABILITY TO PAY, ALL AVAILABLE OPTIONS INCLUDING STATE AND FEDERAL FUNDING AS WELL AS CHARITY CARE ARE DISCUSSED WITH THE PATIENT.
MAYO CLINIC HEALTH SYSTEM - LAKE CITYPART V, SECTION B, LINE 20E: FINANCIAL ASSISTANCE INFORMATION IS AVAILABLE TO EVERY PATIENT VIA MAYO'S PUBLIC WEBSITE, FROM CUSTOMER SERVICE AND PATIENT ACCESS LOCATIONS, AND IS REFERENCED ON MAYO'S AUTHORIZATION FORMS AND STATEMENTS. IN ADDITION, BROCHURES ARE AVAILABLE IN THE ADMISSIONS AREA AND THE PROCESS OF HOW TO APPLY IS AVAILABLE ON THE MAYO CLINIC WEBSITE.UPON ADMISSION, IF THE PATIENT DOES NOT HAVE INSURANCE OR EXPRESSES AN INABILITY TO PAY, MAYO DISCUSSES ALL AVAILABLE OPTIONS INCLUDING STATE AND FEDERAL FUNDING AS WELL AS CHARITY CARE.MONTHLY STATEMENTS ARE SENT TO PATIENTS THAT OUTLINE CURRENT CHARGES AND ACTIONS WITH INSURANCE AND INCLUDES INFORMATION ABOUT MAYO'S CHARITY CARE POLICY. SOME MAYO SITES UTILIZE ADVOCATES TO CONTACT THE PATIENT UPON DISCHARGE TO HELP THEM SECURE GOVERNMENTAL ASSISTANCE OR FINANCIAL ASSISTANCE.EACH CHARITY CARE REVIEW IS DOCUMENTED IN MAYO'S BILLING SYSTEM AND COMMUNICATED TO THE PATIENT. COMPLETED CHARITY CARE FORMS ARE MAINTAINED EITHER IN PAPER OR ELECTRONIC FORMAT. THE PATIENT IS INFORMED REGARDING THE OUTCOME OF THE REVIEW.MAYO OFTEN IDENTIFIES CHARITY CARE OPPORTUNITIES AFTER THE PATIENT HAS BEEN DISMISSED. IN MANY CASES, THIS IS DUE TO LIMITED INSURANCE COVERAGE OR INSURANCE DENIALS AFTER THE SERVICE WAS PERFORMED. IN THESE CASES, WHEN A PATIENT EXPRESSES AN INABILITY TO PAY FOR THEIR SERVICES, STAFF WILL INITIATE A CHARITY REVIEW AS INDICATED BY THE FINANCIAL ASSISTANCE POLICY, WHICH IS AVAILABLE FOR EVERY PATIENT AT MAYOCLINIC.ORG.
MAYO CLINIC HEALTH SYSTEM - LAKE CITYPART V, SECTION B, LINE 22D: OUR POLICY ALLOWS FOR A MINIMUM DISCOUNT OF 50% TO ELIGIBLE INDIVIDUALS WHICH RESULTS IN AN AMOUNT LESS THAN THE AVERAGE OF THE THREE BEST NEGOTIATED COMMERCIAL RATES OR THE BEST NEGOTIATED COMMERCIAL RATE.
FieldValueIRS element (for citing)
Facility4FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
1 - MCHS IN LAKE CITY
500 WEST GRANT STREETLAKE CITYMN55041OUTPATIENT CLINIC & NURSING HOME
3 - MCHS - LAKE CITY IN WABASHA
1202 5TH GRANT BLVD WESTWABASHAMN55981CLINIC
4 - MCHS - LAKE CITY IN PLAINVIEW
275 1ST STREET SWPLAINVEIWMN55964CLINIC
5 - MCHS - LAKE CITY IN ALMA
204 SOUTH MAIN STREETALMAWI54610CLINIC

Supplemental Information Detail SupplementalInformationDetail (15 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3C:MEDICAL INDIGENCY MAY BE USED TO DETERMINE ELIGIBILITY. IF A PATIENT BALANCE EXCEEDS 25% OF THE ANNUAL HOUSEHOLD INCOME, BUT THE PATIENT DOES NOT QUALIFY BASED ON FPG, CHARITY WILL BE ADJUSTED TO A MINIMUM OF THE AMOUNT GENERALLY BILLED (AGB). THE AGB IS DETERMINED USING THE LOOK-BACK METHOD AND CALCULATED USING ALL CLAIMS ALLOWED BY PRIVATE PAY INSURERS (INCLUDING MEDICARE ADVANTAGE) AND MEDICARE (TRADITIONAL) FOR INPATIENT AND OUTPATIENT SERVICES FOR THE YEAR.
PART I, LINE 7:A COST-TO-CHARGE RATIO (FROM WORKSHEET 2) IS USED TO CALCULATE THE AMOUNTS ON LINE 7A-7C (FINANCIAL ASSISTANCE, MEDICAID SHORTFALL, AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS).THE AMOUNTS FOR LINES 7E-7I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND WOULD NOT BE BASED ON A COST-TO-CHARGE RATIO.
PART I, LINE 7, COLUMN (F):THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 484,748.
SCHEDULE H, PART I, LINE 5ATHE FILING ORGANIZATION ESTIMATES CHARITY CARE FOR FINANCIAL PLANNING PURPOSES ONLY. THE ESTIMATED AMOUNT OF CHARITY CARE DOES NOT INFLUENCE OR HAVE ANY IMPACT ON THE AMOUNT OF CHARITY CARE PROVIDED.
PART II, COMMUNITY BUILDING ACTIVITIES:THROUGH DONATIONS AND GRANTS TO PUBLIC, PRIVATE AND NONPROFIT ORGANIZATIONS, THE FILING ORGANIZATION ASSISTS WITH SUSTAINING AND ENHANCING THE COMMUNITIES IT SERVES.
PART III, LINE 2:PART III, SECTION A, LINE 1:THE FILING ORGANIZATION REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES SET FORTH BY GAAP.METHODOLOGY FOR SCHEDULE H, PART III, LINE 2:BAD DEBT EXPENSE IS DETERMINED BASED ON GAAP AND IS EXPLAINED IN THE ACCOUNTS RECEIVABLE FOOTNOTE OF THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS.
PART III, LINE 4:FOOTNOTES RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR DOUBTFUL ACCOUNTS CAN BE FOUND ON PAGES 5, 7, 8 AND 9 OF MAYO CLINIC'S 2015 CONSOLIDATED AUDITED FINANCIAL STATEMENTS.+
PART III, LINE 8:THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. THE MEDICARE SHORTFALL REFLECTED ON SCHEDULE H, PART III, SECTION B WAS DETERMINED USING INFORMATION FROM THE ORGANIZATION'S MEDICARE COST REPORT (USING A MEDICARE COST REPORT STEP-DOWN METHODOLOGY). HOWEVER, USING A FINANCIAL STATEMENT COST-TO-CHARGE RATIO METHODOLOGY ACTUALLY RESULTS IN A MEDICARE SHORTFALL OF $291,008 AS REPORTED IN THE CORE FORM, PART III, PROGRAM SERVICE ACCOMPLISHMENTS.THE MOST COMMON REASONS FOR A DIFFERENCE BETWEEN THE MEDICARE SURPLUS REPORTED ON SCHEDULE H AND THE MEDICARE SHORTFALL REPORTED ON THE CORE FORM, PART III INCLUDE: (1) INCLUSION OF MEDICARE ADVANTAGE REVENUE AND EXPENSES; (2) INCLUSION OF PART B REVENUE AND EXPENSES; (3) INCLUSION OF OTHER FEE SCHEDULE REVENUE; AND (4) SOME TIMING ISSUES.REASONS WHY MEDICARE SHORTFALL REPORTED ON LINE 7, IF ANY, SHOULD BE TREATED AS COMMUNITY BENEFIT ARE: (1) ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALS WOULD QUALIFY FOR FINANCIAL ASSISTANCE OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS; (2) BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS; (3) THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS; AND (4) THE AMOUNT SPENT TO COVER THE MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT NEEDS.
PART III, LINE 9B:MAYO CLINIC AND ITS AFFILIATES STRIVE TO ASSIST ALL PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION PRIOR TO ENLISTING THE ASSISTANCE OF A COLLECTION AGENCY BY MAKING REASONABLE ATTEMPTS TO COLLECT FROM INSURANCE COMPANIES AND OTHER THIRD-PARTY PAYORS. IN ADDITION, MAYO CLINIC AND ITS AFFILIATES ACCEPT REASONABLE PAYMENT PLANS FROM PATIENTS WHEN AN ACCOUNT IS THE PATIENT'S RESPONSIBILITY AND TRY TO IDENTIFY THOSE PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. FINANCIAL ASSISTANCE IS OFFERED TO ANY PATIENT IF THE FACTS AND CIRCUMSTANCES SUGGEST THAT THE PATIENT DOES NOT HAVE THE ABILITY TO PAY THEIR BILL IN WHOLE OR IN PART. IN THE EVENT THAT AN ACCOUNT IS REFERRED TO A COLLECTION AGENCY, GUIDELINES ARE FOLLOWED; INCLUDING SUSPENDING ALL COLLECTION ACTIVITY IF A FINANCIAL ASSISTANCE APPLICATION HAS BEEN SUBMITTED AFTER THE ACCOUNT HAS BEEN REFERRED FOR COLLECTION. IF A COLLECTION AGENCY IDENTIFIES A PATIENT AS POTENTIALLY MEETING MAYO CLINIC'S FINANCIAL ASSISTANCE ELIGIBILITY CRITERIA OR THE PATIENT ASKS TO APPLY FOR FINANCIAL ASSISTANCE, COLLECTION ACTIVITY IS SUSPENDED UNTIL MAYO REVIEWS THE ACCOUNT FOR FINANCIAL ASSISTANCE ELIGIBILITY BASED ON SUBMISSION OF REQUESTED INFORMATION. COLLECTION ACTIVITY WOULD ONLY RESUME IF THE PATIENT IS DETERMINED TO BE INELIGIBLE FOR FINANCIAL ASSISTANCE OR IS ELIGIBLE FOR ONLY PARTIAL FINANCIAL ASSISTANCE AND DOES NOT AGREE TO PAY THE REMAINING BALANCE.
PART VI, LINE 2:MAYO CLINIC HEALTH SYSTEM - LAKE CITY (MCHS-LAKE CITY) EMPLOYEES THROUGHOUT THE ORGANIZATION ASSESS THE NEEDS OF LAKE CITY AND THE SURROUNDING COMMUNITIES THROUGH PERSONAL INTERACTION AND INVOLVEMENT WITH LOCAL SCHOOLS, CIVIC GROUPS AND HEALTH DEPARTMENTS, AS WELL AS THROUGH THE COLLECTION AND ANALYSIS OF FEEDBACK FROM PATIENTS AND COMMUNITY MEMBERS.MCHS-LAKE CITY EMPLOYEES ARE ALSO STRONGLY CONNECTED WITH LOCAL CIVIC GROUPS. MANY EMPLOYEES ARE ACTIVE MEMBERS OF VARIOUS LAKE CITY ORGANIZATIONS, WHILE OTHERS GIVE HEALTHCARE PRESENTATIONS TO THESE GROUPS. THIS PARTICIPATION NOT ONLY PROMOTES INVOLVEMENT IN THE COMMUNITY, BUT ALSO GIVES COMMUNITY MEMBERS A CHANCE TO ASK QUESTIONS, SHARE COMMENTS, CONCERNS OR OTHER SUGGESTIONS THEY MAY HAVE REGARDING THE MEDICAL CENTER. MCHS-LAKE CITY PROVIDES PREVENTIVE HEALTH SCREENINGS THROUGHOUT THE COMMUNITY. MCHS-LAKE CITY ALSO WORKS WITH THE WABASHA PUBLIC HEALTH ORGANIZATION TO DEVELOP RELATIONSHIPS AMONG HEALTH CARE PROVIDERS AND COMMUNITY LEADERS. THIS PARTNERSHIP PROMOTES THE ACTIVE REFERRAL OF PATIENTS TO LOCAL RESOURCES SUCH AS ACCESS TO HIGH QUALITY NUTRITIOUS FOODS, PHYSICAL ACTIVITY AND TOBACCO USE CESSATION PROGRAMS. MCHS-LAKE CITY ACTIVELY SEEKS FEEDBACK FROM PATIENTS AND COMMUNITY MEMBERS THROUGH ITS PATIENT ADVISORY COUNCIL (PAC) AND PATIENT SATISFACTION SURVEYS. THE PAC IS A GROUP OF TEN COMMUNITY MEMBERS WHO SERVE AS A MCHS-CANNON FALLS/LAKE CITY /RED WING FOCUS GROUP TO PROVIDE FEEDBACK PRIOR TO THE IMPLEMENTATION OF NEW PROGRAMS AND SERVICES, ASSIST IN THE IDENTIFICATION OF OPPORTUNITIES THAT WILL IMPROVE PATIENT AND FAMILY SATISFACTION, PROVIDE TIMELY AND DIRECT INPUT INTO MCHS-LAKE CITY SYSTEM AND PROCESS CHANGES, OFFER INPUT TO LEADERSHIP IN THE PLANNING AND EVALUATION OF SERVICES, AND SERVE AS A VITAL LINK BETWEEN MCHS-LAKE CITY AND THE COMMUNITY.MCHS-LAKE CITY STAFF IS TRAINED TO IDENTIFY PATIENTS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE PROGRAMS. THE ORGANIZATION HAS PROGRAMS IN PLACE FOR FINANCIAL ASSISTANCE TO HELP THOSE WHO ARE IN NEED OF HEALTH CARE BUT HAVE NO INSURANCE OR ARE NOT ABLE TO RECEIVE OTHER FINANCIAL ASSISTANCE. AS THESE EXAMPLES OF INVOLVEMENT DEMONSTRATE, MCHS-LAKE CITY IS CLOSELY CONNECTED WITH THE COMMUNITY. IN ADDITION TO THIS, MCHS- LAKE CITY ACTIVELY SEEKS FEEDBACK FROM PATIENTS AND COMMUNITY MEMBERS THROUGH AVATAR SURVEYS. THE SURVEY IS SENT TO A CROSS SECTION OF PATIENTS TO COMPILE USEFUL FEEDBACK ON WAYS MCHS-LAKE CITY CAN IMPROVE CUSTOMER SERVICES AND DETERMINE WHETHER OR NOT THERE IS A NEED FOR NEW OR EXPANDED SERVICES. THE DATA FROM THE SURVEY IS REVIEWED AND ANALYZED BY MEMBERS OF QUALITY AND ADMINISTRATION DEPARTMENTS AS WELL AS MCHS-LAKE CITY EMERGENCY ROOM (ER)/INPATIENT SATISFACTION TEAM, A TEAM DEDICATED TO IMPROVING PATIENT SATISFACTION IN THE ER AND HOSPITAL.THROUGH THESE VARIOUS AVENUES, MCHS-LAKE CITY STAFF MEMBERS ACROSS MANY DEPARTMENTS STAY CONNECTED WITH THE COMMUNITY TO ASSESS THE HEALTHCARE NEEDS OF LAKE CITY AND SURROUNDING AREAS.
PART VI, LINE 3:MEASURES TO PUBLICIZE FINANCIAL ASSISTANCE POLICY:MAYO CLINIC IS COMMITTED TO OFFERING FINANCIAL ASSISTANCE TO ELIGIBLE PATIENTS WHO DO NOT HAVE THE ABILITY TO PAY FOR THEIR MEDICAL SERVICES IN WHOLE OR IN PART. IN ORDER TO ACCOMPLISH THIS CHARITABLE GOAL, MAYO CLINIC AND MAYO CLINIC HEALTH SYSTEM SITES WIDELY PUBLICIZE THIS POLICY IN THE COMMUNITIES THAT THE INDIVIDUAL MAYO CLINIC AFFILIATED SITES SERVE. MAYO CLINIC AFFILIATED SITES MAKE COPIES OF THIS POLICY AND APPLICATIONS AVAILABLE BY POSTING IT ON THEIR WEBPAGE INCLUDING THE ABILITY TO DOWNLOAD A COPY OF THE POLICY AND APPLICATION FREE OF CHARGE. INDIVIDUALS IN THE COMMUNITY SERVED WILL BE ABLE TO OBTAIN A COPY OF THE POLICY IN LOCATIONS THROUGHOUT EACH MAYO CLINIC AFFILIATED SITE OR UPON REQUEST. THE POLICY EXPLAINS THE FINANCIAL ASSISTANCE PROGRAM AND FACTORS AFFECTING ELIGIBILITY. WITHIN THE HOSPITAL FACILITY, A BROCHURE IS MADE AVAILABLE IN NUMEROUS LOCATIONS THROUGHOUT THE FACILITY WHICH DESCRIBES THE FINANCIAL ASSISTANCE POLICY, HOW TO APPLY FOR FINANCIAL ASSISTANCE, AND GIVES THE INTERNET ADDRESS WHERE THE COMPLETE POLICY CAN BE OBTAINED. ADDITIONALLY, CHARITABLE CARE AND FINANCIAL ASSISTANCE IS REFERENCED ON PATIENT CORRESPONDENCE INCLUDING: THE MONTHLY STATEMENT OF ACCOUNT, ACCOUNT BALANCE LETTERS, AND LATE PAYMENT NOTIFICATIONS. ALL PATIENT CORRESPONDENCE REFERENCING CHARITABLE CARE AND FINANCIAL ASSISTANCE INCLUDE INTERNET, PHONE, AND MAILING ADDRESS CONTACT INFORMATION.
PART VI, LINE 4:MCHS-LAKE CITY HAS LOCATIONS IN LAKE CITY, PLAINVIEW AND WABASHA, MINNESOTA, AS WELL AS IN ALMA, WISCONSIN. THE MAJORITY OF MCHS-LAKE CITY'S SERVICE AREAS INCLUDE GOODHUE AND WABASHA COUNTIES IN SOUTHEASTERN MINNESOTA AND BUFFALO COUNTY IN SOUTHWESTERN WISCONSIN. THE MAIN CAMPUS, LOCATED IN LAKE CITY, HOUSES AN 18-BED CRITICAL ACCESS HOSPITAL, A 90-BED NURSING HOME AND A HOSPITAL-BASED CLINIC WITH 37 PROVIDERS THAT SERVE LAKE CITY AND SURROUNDING COMMUNITIES. ACCORDING TO THE UNITED STATES CENSUS BUREAU, THE ESTIMATED 2015 POPULATION FOR WABASHA COUNTY (WHICH COMPRISES MOST OF LAKE CITY'S SERVICE AREA) IS 21,239. 22.1% OF WABASHA COUNTY IS ESTIMATED TO BE UNDER THE AGE OF 18 AND 19.2% IS ESTIMATED TO BE OVER THE AGE OF 65. THE ESTIMATED POPULATION OF LAKE CITY IS 5,027. THE MEDIAN HOUSEHOLD INCOME OF LAKE CITY, BASED ON THE YEARS 2010-2014 IS $48,390 AS COMPARED TO $55,994 FOR WABASHA COUNTY. AN ESTIMATED 7.1% OF INDIVIDUALS IN LAKE CITY ARE LIVING BELOW THE POVERTY LEVEL AND FOR WABASHA COUNTY THE ESTIMATE IS 7.3%.
PART VI, LINE 5:THE FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES ARE LARGE, MULTI-FACETED, INTEGRATED, NOT-FOR-PROFIT GROUP PRACTICES AND HEALTH SYSTEMS. AT MAYO CLINIC, DOCTORS FROM EVERY MEDICAL SPECIALTY WORK TOGETHER TO CARE FOR PATIENTS, JOINED BY COMMON SYSTEMS AND A PHILOSOPHY OF "THE NEEDS OF THE PATIENT COME FIRST." THE ORGANIZATIONS (INCLUDING HOSPITAL AND NON-HOSPITAL ENTITIES) WORK TOGETHER TO SERVE THEIR COMMUNITIES AT THE LOCAL, REGIONAL, NATIONAL, AND GLOBAL LEVELS. THIS COMMUNITY BENEFIT HAPPENS THROUGH ITS FOCUS ON PATIENT CARE, EDUCATION, AND RESEARCH. SPECIFICALLY, THE TAX-EXEMPT PURPOSE OF MAYO CLINIC AND ITS AFFILIATES IS THREE-FOLD:PRACTICE - PRACTICE MEDICINE AS AN INTEGRATED TEAM OF COMPASSIONATE, MULTI-DISCIPLINARY PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS WHO ARE FOCUSED ON THE NEEDS OF PATIENTS FROM OUR COMMUNITIES, REGIONS, THE NATION AND THE WORLD.EDUCATION - EDUCATE PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS AND BE A DEPENDABLE SOURCE OF HEALTH INFORMATION FOR OUR PATIENTS AND THE PUBLIC.RESEARCH - CONDUCT BASIC AND CLINICAL RESEARCH PROGRAMS TO IMPROVE PATIENT CARE AND TO BENEFIT SOCIETY, INCLUDING PARTNERING WITH MAYO CLINIC HEALTH SYSTEM PRACTICES TO PERFORM PRACTICE-BASED RESEARCH DESIGNED TO IMPROVE PATIENT CARE.THROUGH ITS MISSION, MAYO CLINIC AND ITS AFFILIATES ENRICH THE COMMUNITIES IN WHICH THEY OPERATE AS WELL AS THE BROADER COMMUNITY - IMPROVING MEDICINE THROUGH RESEARCH, EDUCATING PHYSICIANS AND OTHER HEALTH CARE PROVIDERS, AND PROVIDING CARE AND SUPPORT TO PEOPLE IN NEED. PLEASE REFER TO THE PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, FOR FURTHER DESCRIPTION OF THE FILING ORGANIZATION'S ACTIVITIES.SURPLUS FUNDS:MAYO CLINIC AND ITS AFFILIATES REINVEST THEIR NET OPERATING INCOME TO ADVANCE MEDICAL RESEARCH AND TEACH THE NEXT GENERATION OF HEALTH CARE PROFESSIONALS, AS WELL AS TO ALLOW THE INDIVIDUAL ENTITY TO SUSTAIN ITS MISSION AND PREPARE FOR THE FUTURE. COMMUNITY REPRESENTATION ON GOVERNING BODY:THE BOARD OF TRUSTEES IS THE GOVERNING BODY OF MAYO CLINIC. A MAJORITY OF ITS MEMBERS ARE EXTERNAL, INDEPENDENT TRUSTEES. IT HAS OVERALL RESPONSIBILITY FOR THE CHARITABLE, CLINICAL PRACTICE, SCIENTIFIC AND EDUCATIONAL MISSION AND PURPOSES OF MAYO CLINIC AND ITS AFFILIATES AS SET FORTH IN ITS ARTICLES OF INCORPORATION AND BYLAWS. BECAUSE OF MAYO CLINIC'S NATIONAL PRESENCE, THESE TRUSTEES ARE SELECTED BASED ON THEIR AREAS OF EXPERTISE, WHETHER IN HEALTH CARE POLICY, BUSINESS, GOVERNMENT OR ANOTHER FIELD. IN ADDITION TO THIS COMMUNITY REPRESENTATION AT THE PARENT ENTITY, THE FILING ORGANIZATION ALSO INVOLVES LOCAL COMMUNITY MEMBERS ON ITS GOVERNING BODY. OPEN V. CLOSED STAFF MODEL:THE FILING ORGANIZATION'S STAFF PRIVILEGES ARE GENERALLY EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY.EMERGENCY ROOM:THE FILING ORGANIZATION MAINTAINS AN EMERGENCY ROOM 24 HOURS A DAY, 7 DAYS A WEEK, WHICH IS OPEN TO ALL WITHOUT REGARD TO THE ABILITY TO PAY.
PART VI, LINE 6:THIS ORGANIZATION IS A PART OF MAYO CLINIC HEALTH SYSTEM (WHICH IS PART OF A LARGER GROUP OF ENTITIES AFFILIATED WITH MAYO CLINIC). THE MAYO CLINIC HEALTH SYSTEM IS DESCRIBED IN RESPONSE TO CORE FORM, PART III, STATEMENT OF PROGRAM ACCOMPLISHMENTS, LINE 4A (REPORTED IN SCHEDULE O). THAT STATEMENT ALSO DESCRIBES THE ROLES OF THE VARIOUS AFFILIATES IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED.
PART VI, LINE 7NEITHER THE FILING ORGANIZATION, NOR ANY RELATED ORGANIZATION, FILES A COMMUNITY BENEFIT REPORT WITH ANY STATE OTHER THAN THE EXTENT TO WHICH COMMUNITY BENEFIT INFORMATION IS INCLUDED IN OTHER REPORTING REQUIREMENTS SUCH AS INFORMATION PROVIDED TO A STATE HOSPITAL ASSOCIATION.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmYes (1)EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (16 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
AGERTER MD DAVID C
DIRECTOR/REGION CEO$0$523,301$0$0$0$74,291$0$10,639$0$15,567$0$623,798$0$0
SOLBERG MD JEREMY J
DIRECTOR$242,264$0$0$0$432$0$26,875$0$19,933$0$289,504$0$0$0
SPANO MD DENNIS C
DIRECTOR/VICE CHAIR$419,507$0$0$0$98,680$0$32,623$0$24,212$0$575,022$0$0$0
WILKINSON MD JOHN M
DIRECTOR$0$236,781$0$0$0$18,909$0$10,191$0$15,308$0$281,189$0$0
WITT MD THOMAS J
DIRECTOR/CHAIR$425,606$0$0$0$48,467$0$52,327$0$17,502$0$543,902$0$0$0
GUDGELL STEPHEN F
RIVER CORRIDOR CAO$0$201,637$0$0$0$1,391$0$8,287$0$16,048$0$227,363$0$0
KOCH MARK B
ASS'T SECRETARY$0$446,213$0$0$0$36,983$0$10,710$0$12,967$0$506,873$0$0
PARKS DOUGLAS A
REGION CAO$0$236,962$0$0$0$2,137$0$28,462$0$21,555$0$289,116$0$0
STIENE SUSAN M
SECRETARY$164,526$0$0$0$3,738$0$30,261$0$13,521$0$212,046$0$0$0
TARASOVITCH JAMES J
REGION CFO$0$301,807$0$0$0$7,337$0$47,461$0$19,489$0$376,094$0$0
ADAMSON MD STEVEN C
PHYSICIAN$298,468$0$0$0$33,102$0$40,979$0$14,810$0$387,359$0$0$0
ANDERSON DO TRENT D
PHYSICIAN$247,178$0$0$0$285$0$18,126$0$23,092$0$288,681$0$0$0
FOSS MD RANDY M
PHYSICIAN$258,777$0$0$0$1,980$0$11,506$0$15,488$0$287,751$0$0$0
RENELT MD JOHN A
PHYSICIAN$317,361$0$0$0$79,058$0$37,937$0$23,909$0$458,265$0$0$0
SCHWEND DO PHILLIP P
PHYSICIAN$300,855$0$0$0$30,289$0$48,209$0$12,998$0$392,351$0$0$0
BROWN MARK C
FORMER OFFICER$0$155,684$0$0$0$696$0$17,407$0$21,778$0$195,565$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3THE FILING ORGANIZATION RELIED ON A RELATED ORGANIZATION FOR ESTABLISHING THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. SEE CORE 990 PART VI SECTION B LINE 15 FOR FURTHER INFORMATION REGARDING THE PROCESS UTILIZED.
PART I, LINES 4B-CTHIS ENTITY OR ITS AFFILIATE HAS A SUPPLEMENTAL RETIREMENT PLAN (SRP) DESIGNED TO ROUGHLY APPROXIMATE AN EXTENSION OF THE BENEFITS UNDER THE MAYO PENSION PLAN TO INCOME ABOVE THE INTERNAL REVENUE CODE QUALIFIED PLAN LIMIT IN SECTION 401(A)(17). STARTING JANUARY 1, 2011, ALL SRP BENEFITS ARE PAID AS AN ANNUAL TAXABLE CASH PAYMENT. THE FOLLOWING INDIVIDUALS PARTICIPATED IN OR RECEIVED A PAYMENT FROM THE SUPPLEMENTAL RETIREMENT PLAN. AMOUNTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III). ADAMSON M.D., STEVEN C. $17,867 AGERTER M.D., DAVID C. $67,586 KOCH, MARK B. $33,730 RENELT M.D., JOHN A. $13,680 SCHWEND D.O., PHILLIP P. $ 1,718 SPANO M.D., DENNIS C. $45,790 TARASOVITCH, JAMES J. $ 0 WITT M.D., THOMAS J. $42,856 UNDER MAYO CLINIC'S ROYALTY SHARING POLICY, INVENTORS, INCLUDING LISTED PERSONS, ARE ENTITLED TO SHARE IN A PORTION OF ROYALTIES RECEIVED BY MAYO INCLUDING INSTANCES WHERE SUCH ROYALTIES ARE IN THE FORM OF EQUITY-BASED INSTRUMENTS SUCH AS STOCK, WARRANTS, OR PARTNERSHIP INTERESTS. THE FOLLOWING INDIVIDUALS PARTICIPATED IN AN EQUITY-BASED COMPENSATION ARRANGEMENT: GUDGELL, STEPHEN F.
PART II:COMPENSATION PAID TO BOARD MEMBERS IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS PHYSICIANS, ADMINISTRATORS, OR EMPLOYEES OF THE ORGANIZATION.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
LAURA S MARQUARDT
FAMILY MEMBER OF OFFICER SUSAN STIENE$57,037COMPENSATION0
LISA J GRUBER
FAMILY MEMBER OF DIRECTOR JOHN GRUBER$36,816COMPENSATION0
MAUREEN T SULLIVAN-SPANO
FAMILY MEMBER OF DIRECTOR DENNIS SPANO M.D.$11,290COMPENSATION0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 2THE FOLLOWING INDIVIDUAL(S) IS/ARE EMPLOYED BY A RELATED ORGANIZATION: TARASOVITCH, JAMES J. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUAL(S) WHO IS/ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: KOCH, MARK B.
FORM 990, PART VI, SECTION A, LINE 3MAYO CLINIC, MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH, AND OTHER RELATED COMPANIES PROVIDE MANAGEMENT SERVICES TO THE ENTIRE SYSTEM OF ENTITIES. SINCE THE ENTITIES ARE RELATED ORGANIZATIONS, COMPENSATION FOR THE OFFICERS, DIRECTORS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES HAS BEEN DISCLOSED IN PART VII AND SCHEDULE J AS REQUIRED.
FORM 990, PART VI, SECTION A, LINE 6THE SOLE CORPORATE MEMBER IS MAYO CLINIC.
FORM 990, PART VI, SECTION A, LINE 7ATHE SOLE CORPORATE MEMBER ELECTS THE GOVERNING BODY. ONE MEMBER IS ELECTED FROM A SLATE OF NOMINEES PROVIDED BY THE CITY COUNCIL OF LAKE CITY.
FORM 990, PART VI, SECTION A, LINE 7BTHE BYLAWS PROVIDE THE SOLE CORPORATE MEMBER CERTAIN RESERVED POWERS IN AREAS SUCH AS DEBT, AMENDMENT OF THE BYLAWS, MERGERS, AND NEW SERVICES. AMENDMENTS OF THE ARTICLES OF INCORPORATION OR BYLAWS MUST BE APPROVED BY THE SOLE CORPORATE MEMBER.
FORM 990, PART VI, SECTION A, LINE 8BTHE FILING ORGANIZATION HAS NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE BOARD.
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 IS PREPARED BY MAYO CORPORATE TAX WITH ASSISTANCE FROM SITE ACCOUNTING STAFF. THE TAX RETURN GOES THROUGH TWO LEVELS OF REVIEW WITHIN THE CORPORATE TAX UNIT. IT IS THEN REVIEWED BY THE REGION CHIEF FINANCIAL OFFICER AND FINANCE DIRECTOR, ALONG WITH SITE FINANCE STAFF. A COPY OF THE FORM 990 IS THEN PROVIDED TO EACH MEMBER OF THE FILING ORGANIZATION'S GOVERNING BODY VIA US MAIL, E-MAIL, OR DISTRIBUTION AT A BOARD MEETING. ALL QUESTIONS ARE ADDRESSED PRIOR TO FILING THE FORM 990.
FORM 990, PART VI, SECTION B, LINE 12CMAYO CLINIC AND ITS AFFILIATES HAVE A COMPREHENSIVE CONFLICT OF INTEREST POLICY APPLICABLE TO ALL OF THE AFFILIATED ENTITIES AND TO ALL DIRECTORS, OFFICERS, AND EMPLOYEES OF THOSE ENTITIES. ALL CURRENT AND FORMER OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES WHO WE ANTICIPATE WILL BE LISTED ON A FORM 990 ARE ASKED TO COMPLETE AN "ANNUAL TAX AND COMPLIANCE DISCLOSURE" FORM. THIS INFORMATION IS REVIEWED BY BOTH THE CORPORATE TAX DEPARTMENT AND THE OFFICE OF CONFLICT OF INTEREST REVIEW. ALL DISCLOSURES OF CURRENT OR PROPOSED ACTIVITY THAT REQUIRE ACTION UNDER THE POLICY ARE THE SUBJECT OF ONGOING REVIEW AND ACTION THROUGH THE OFFICE OF CONFLICT OF INTEREST REVIEW AND THE CONFLICT OF INTEREST REVIEW BOARD. INVOLVED INDIVIDUALS ARE INFORMED OF ALL REQUIRED ACTION. MANY TYPES OF RELATIONSHIPS THAT COULD CREATE CONFLICTS OF INTEREST ARE PROHIBITED. OTHER TYPES OF RELATIONSHIPS ARE PERMITTED SUBJECT TO COMPLIANCE WITH THE MANAGEMENT PLAN ESTABLISHED BY THE CONFLICT OF INTEREST REVIEW BOARD. A COMMON MANAGEMENT STRATEGY FOR PERMITTED ACTIVITIES IS TO REQUIRE BILATERAL RECUSAL AND APPROPRIATE DOCUMENTATION IN THE MINUTES OF MAYO CLINIC (AND/OR AFFILIATE) AND THE OUTSIDE ENTITY. ADDITIONAL CONFLICT OF INTEREST POLICIES AND PROCEDURES EXIST FOR CERTAIN ENTITIES CONCERNING RESEARCH CONTRACTS AND OTHER TYPES OF POTENTIAL CONFLICTS.
FORM 990, PART VI, SECTION B, LINE 15THE FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES HAVE A COORDINATED PROCESS FOR REVIEWING AND APPROVING COMPENSATION AND BENEFITS FOR PHYSICIANS, EXECUTIVE AND SENIOR ADMINISTRATIVE LEADERSHIP, ALONG WITH ALLIED HEALTH STAFF. IN ADDITION TO ANY REVIEW AND APPROVAL THAT MAY TAKE PLACE AT THE LOCAL ENTITY OR REGIONAL LEVEL, THE FOLLOWING INDEPENDENT APPROVAL PROCESS OCCURS ANNUALLY PRIOR TO IMPLEMENTATION OF THE RESPECTIVE COMPENSATION INCREASE. THE SALARIES AND BENEFIT PROGRAMS OF THE CHIEF EXECUTIVE OFFICER (CEO) AND THE CHIEF ADMINISTRATIVE OFFICER (CAO) WERE REVIEWED AND APPROVED BY THE PROCESS DESCRIBED BELOW FOR SENIOR ADMINISTRATIVE LEADERSHIP. THE COMPENSATION AND BENEFIT PROGRAMS FOR SENIOR ADMINISTRATIVE LEADERSHIP FOR ALL CAMPUSES, INCLUDING THE MAYO CLINIC HEALTH SYSTEM LOCATIONS, ARE REVIEWED AND APPROVED BY THE MAYO CLINIC BOARD OF TRUSTEES GOVERNANCE AND NOMINATING COMMITTEE. THE MAYO CLINIC BOARD OF TRUSTEES GOVERNANCE AND NOMINATING COMMITTEE IS COMPRISED OF NINE OF THE EXTERNAL INDEPENDENT MEMBERS OF THE MAYO CLINIC BOARD OF TRUSTEES. THIS GROUP REVIEWS AND APPROVES THE COMPENSATION AND BENEFIT PROGRAMS FOR PHYSICIANS FROM ALL CAMPUSES, AS WELL AS CERTAIN SENIOR ADMINISTRATIVE AND EXECUTIVE LEADERSHIP (INCLUDING ALL PERSONS BELIEVED TO BE DISQUALIFIED PERSONS). THIS PROCESS ESTABLISHES ACCEPTABLE RANGES FOR VARIOUS POSITIONS, LEVELS, AND SPECIALTIES. THE COMMITTEE USES COMPARABILITY DATA (INCLUDING THIRD-PARTY BENCHMARKING SURVEYS) IN ITS REVIEW AND DOCUMENTS DECISIONS IN ITS MINUTES.
FORM 990, PART VI, SECTION C, LINE 19THE FILING ORGANIZATION'S GOVERNING DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC. THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST AND ALSO ON THE MAYOCLINIC.ORG WEBSITE. THE FILING ORGANIZATION IS A HOSPITAL AFFILIATED WITH MAYO CLINIC. AS SUCH, MAYO CLINIC'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO THE FILING ORGANIZATION'S FORM 990 AND WOULD BE AVAILABLE UPON REQUEST OF THE FORM 990.
FORM 990, PART IX, LINE 11GI/C PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 4,795,388. MANAGEMENT AND GENERAL EXPENSES 1,738,446. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,533,834. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 7,162,548. MANAGEMENT AND GENERAL EXPENSES 1,288,682. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,451,230.
FILING OF CERTAIN FOREIGN FORMSDISCLOSURE STATEMENT RELATED TO FORMS 5713: FORM 5713 HAS BEEN FILED BY THE FOLLOWING MEMBERS OF THE CONTROLLED GROUP: MAYO CLINIC (EIN: 41-6011702) MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH (EIN: 41-1506440) DISCLOSURE STATEMENT RELATED TO FORMS 5471: UNDER THE CONSTRUCTIVE OWNERSHIP RULES OF IRC SECTIONS 958(A) AND (B), THE TAXPAYER IS REQUIRED TO FILE FORMS 5471, INFORMATION RETURN OF U.S. PERSONS WITH RESPECT TO CERTAIN FOREIGN CORPORATIONS, AS A CATEGORY 4 AND 5 FILER WITH RESPECT TO CERTAIN CONTROLLED FOREIGN CORPORATIONS (CFCS). THESE FILING REQUIREMENTS ARE OR WILL BE SATISFIED THROUGH THE FILING OF FORMS 5471 FOR THESE CFCS BY OTHER U.S. TAXPAYERS IDENTIFIED BELOW WHO HAVE THE SAME FILING REQUIREMENT. TAXPAYER NAME: MAYO CLINIC ADDRESS: 200 FIRST STREET SW, ROCHESTER, MN 55905 ID NUMBER OF U.S. TAX RETURN WITH WHICH FORM 5471 WAS FILED: 41-6011702 IRS SERVICE CENTER WHERE U.S. TAX RETURN WAS OR WILL BE FILED: E-FILED TAXPAYER NAME: MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH ADDRESS: 200 FIRST STREET SW, ROCHESTER, MN 55905 ID NUMBER OF U.S. TAX RETURN WITH WHICH FORM 5471 WAS FILED: 41-1506440 IRS SERVICE CENTER WHERE U.S. TAX RETURN WAS OR WILL BE FILED: E-FILED DISCLOSURE STATEMENT RELATED TO FORMS 8865: UNDER THE CONSTRUCTIVE OWNERSHIP RULES OF IRC SECTIONS 958(A) AND (B), THE TAXPAYER IS REQUIRED TO FILE FORMS 8865, INFORMATION RETURN OF U.S. PERSONS WITH RESPECT TO CERTAIN FOREIGN PARTNERSHIPS, AS A CATEGORY 2 AND 3 FILER. THESE FILING REQUIREMENTS ARE OR WILL BE SATISFIED THROUGH THE FILING OF FORMS 8865 FOR THESE PARTNERSHIPS BY OTHER U.S. TAXPAYERS IDENTIFIED BELOW WHO HAVE THE SAME FILING REQUIREMENT. TAXPAYER NAME: MAYO CLINIC ADDRESS: 200 FIRST STREET SW, ROCHESTER, MN 55905 ID NUMBER OF U.S. TAX RETURN WITH WHICH FORM 8865 WAS FILED: 41-6011702 IRS SERVICE CENTER WHERE U.S. TAX RETURN WAS OR WILL BE FILED: E-FILED

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (38 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACdAddress Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmCountryForeignAddress/CountryCdLegal Domicile Foreign CountryLegalDomicileForeignCountryCd
BLOOMER LAKEVIEW INC
2110 DUNCAN ROADBLOOMERWI54724391450617LOW INCOME HOUSINGWI501(C)(3)7MCHS--CHIPPEWA VALLEY INCYes (1)
CHARTERHOUSE INC
200 FIRST STREET SWROCHESTERMN55905411405254RETIREMENT LIVING CENTERMN501(C)(3)9MAYO CLINICYes (1)
DESTINATION MEDICAL CENTER EDA
50 SOUTH SIXTH STREET SUITE 1500MINNEAPOLISMN554021498464893585ECONOMIC DEVELOPMENTMN501(C)(3)11-IMAYO CLINICYes (1)
GOLD CROSS AMBULANCE SERVICE
200 FIRST STREET SWROCHESTERMN55905411917516AMBULANCE SERVICEMN501(C)(3)9MFMERYes (1)
LUTHER LAKESIDE APARTMENTS INC
PO BOX 1510EAU CLAIREWI54702391409024LOW INCOME HOUSING FOR ELDERLYWI501(C)(3)9MCHS--EAU CLAIRE HOSPITAL INCYes (1)
MAYO CLINIC
200 FIRST STREET SWROCHESTERMN55905416011702PATIENT CARE - CLINICMN501(C)(3)9Yes (1)N/A
MAYO CLINIC ARIZONA
13400 EAST SHEA BOULEVARDSCOTTSDALEAZ85259860800150HOSPITAL AND CLINICAZ501(C)(3)3MAYO CLINICYes (1)
MAYO CLINIC FLORIDA (A NONPROFIT CORPORATION)
4500 SAN PABLO ROADJACKSONVILLEFL32224590714831HOSPITALFL501(C)(3)3MAYO CLINIC JACKSONVILLEYes (1)
MAYO CLINIC HOSPITAL -- ROCHESTER
200 FIRST STREET SWROCHESTERMN55905410944601HOSPITALMN501(C)(3)3MAYO CLINICYes (1)
MAYO CLINIC JACKSONVILLE
4500 SAN PABLO ROADJACKSONVILLEFL32224593337028PATIENT CARE - CLINICFL501(C)(3)7MAYO CLINICYes (1)
MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH
200 FIRST STREET SWROCHESTERMN55905411506440CHARITABLE, EDUCATIONAL & SCIENTIFIC ACTIVITIESMN501(C)(3)9MAYO CLINICYes (1)
MAYO CLINIC STIFTUNG
FUNDRAISING FOUNDATIONMFMERYes (1)60486 FRANKFURT AM MAINFRANKFURTGMGM
MCHS IN WAYCROSS INC
1900 TEBEAU STREETWAYCROSSGA31501581667166HOSPITALGA501(C)(3)3MAYO CLINIC JACKSONVILLEYes (1)
MCHS--ALBERT LEA AND AUSTIN
1000 FIRST DRIVE NWAUSTINMN55912411404075HOSPITAL AND CLINICMN501(C)(3)3MAYO CLINICYes (1)
MCHS--AUSTIN FOUNDATION
1000 FIRST DRIVE NWAUSTINMN55912300107471FUNDRAISING FOUNDATIONMN501(C)(3)7MCHS--ALBERT LEA AND AUSTINYes (1)
MCHS--CANNON FALLS
32021 COUNTY ROAD 24 BLVDCANNON FALLSMN55009204156428HOSPITAL AND CLINICMN501(C)(3)3MAYO CLINICYes (1)
MCHS--CHIPPEWA VALLEY INC
1501 THOMPSON STREETBLOOMERWI54724390980343HOSPITAL AND CLINICWI501(C)(3)3MCHS--EAU CLAIRE HOSPITAL INCYes (1)
MCHS--EAU CLAIRE CLINIC INC
733 W CLAIREMONT AVE PO BOX 1510EAU CLAIREWI54702391735831PATIENT CARE - CLINICWI501(C)(3)3MAYO CLINICYes (1)
MCHS--EAU CLAIRE FOUNDATION INC
733 W CLAIREMONT AVE PO BOX 1510EAU CLAIREWI54702391633407GRANTMAKING FOUNDATIONWI501(C)(3)11-IMCHS--EAU CLAIRE CLINIC INCYes (1)
MCHS--EAU CLAIRE HOSPITAL INC
1221 WHIPPLE STREETEAU CLAIREWI54703390813418HOSPITALWI501(C)(3)3MAYO CLINICYes (1)
MCHS--FAIRMONT
800 MEDICAL CENTER DRIVE PO BOX 800FAIRMONTMN56031410760836HOSPITAL AND CLINICMN501(C)(3)3MCHS--MANKATOYes (1)
MCHS--FRANCISCAN HEALTHCARE FOUNDATION INC
700 WEST AVE SOUTHLA CROSSEWI54601391186647FUNDRAISING FOUNDATIONWI501(C)(3)7MCHS--FRANCISCAN HEALTHCARE INCYes (1)
MCHS--FRANCISCAN HEALTHCARE INC
700 WEST AVE SOUTHLA CROSSEWI54601391411999HEALTHCARE SYSTEM PARENTWI501(C)(3)11-IMAYO CLINICYes (1)
MCHS--FRANCISCAN MEDICAL CENTER INC
700 WEST AVE SOUTHLA CROSSEWI54601390806374HOSPITAL AND CLINICWI501(C)(3)3MCHS--FRANCISCAN HEALTHCARE INCYes (1)
MCHS--LAKE CITY
500 WEST GRANT STREETLAKE CITYMN55041411906820HOSPITALMN501(C)(3)3MAYO CLINICYes (1)
MCHS--MANKATO
1025 MARSH STREETMANKATOMN56002411236756HOSPITAL AND CLINICMN501(C)(3)3MAYO CLINICYes (1)
MCHS--MANKATO HEALTH CARE FOUNDATION
1025 MARSH STREETMANKATOMN56002411663357FUNDRAISING FOUNDATIONMN501(C)(3)7MCHS--MANKATOYes (1)
MCHS--NEW PRAGUE
301 SECOND STREET NENEW PRAGUEMN56071410723639HOSPITAL AND CLINICMN501(C)(3)3MCHS--MANKATOYes (1)
MCHS--NORTHLAND INC
1222 EAST WOODLAND AVENUEBARRONWI54812390920634HOSPITAL AND CLINICWI501(C)(3)3MCHS--EAU CLAIRE HOSPITAL INCYes (1)
MCHS--OAKRIDGE INC
13025 EIGHTH STREET PO BOX 70OSSEOWI54758391029430HOSPITAL AND CLINICWI501(C)(3)3MCHS--EAU CLAIRE HOSPITAL INCYes (1)
MCHS--OWATONNA
134 SOUTHVIEW STOWATONNAMN55060411862132PATIENT CARE - CLINICMN501(C)(3)3MAYO CLINICYes (1)
MCHS--RED CEDAR INC
2321 STOUT ROADMENOMONIEWI54751510190875HOSPITAL AND CLINICWI501(C)(3)3MCHS--EAU CLAIRE HOSPITAL INCYes (1)
MCHS--RED WING
701 HEWITT BOULEVARDRED WINGMN55066411713783PATIENT CARE SERVICESMN501(C)(3)3MAYO CLINICYes (1)
MCHS--SPRINGFIELD
625 NORTH JACKSON AVENUESPRINGFIELDMN56087411893827HOSPITAL AND CLINICMN501(C)(3)3MCHS--MANKATOYes (1)
MCHS--ST JAMES
1101 MOULTON PARSONS DR PO BOX 460ST JAMESMN56081410797368HOSPITAL AND CLINICMN501(C)(3)3MCHS--MANKATOYes (1)
MCHS--WASECA
501 NORTH STATE STREETWASECAMN56093363606405HOSPITAL AND CLINICMN501(C)(3)3MCHS--MANKATOYes (1)
MILES AND SHIRLEY FITERMAN ENDOWMENT FUND FOR DIGESTIVE DISEASES
200 FIRST STREET SWROCHESTERMN55905412020392SUPPORT RESEARCH, PRACTICE & EDUCATIONMN501(C)(3)11-IMAYO CLINICYes (1)
POVERELLO FOUNDATION
200 FIRST STREET SWROCHESTERMN55905411494881FUNDRAISING FOUNDATIONMN501(C)(3)7MAYO CLINIC HOSPITAL - ROCHESTERYes (1)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACd
FRANKLIN HEATING STATION
119 THIRD ST SWROCHESTERMN55902410264830UTILITYMNN/A
LATIGO PETROLEUM LLC
PO BOX 14230ODESSATX79768364767494OIL & GAS EXPLORATIONDEN/A
WATERSHED CAP INSTL PRTNRS III LP
ONE MARITIME PLAZA SUITE 1525SAN FRANCISCOCA94111462982848INVESTMENT ACTIVITIESDEN/A

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (37 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationIndAddress Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmCountryForeignAddress/CountryCdLegal Domicile Foreign CountryLegalDomicileForeignCountryCd
AMBIENT CLINICAL ANALYTICS INC
221 1ST AVE SW SUITE 202ROCHESTERMN55902800928405SOFTWAREDEN/ACYes (1)
BWL HOLDINGS INC
1209 ORANGE STREETWILMINGTONDE19801472413749OIL & GAS EXPLORATIONDEN/ACYes (1)
CAVALRY CLO III LTD
INVESTMENT ACTIVITIESN/ACYes (1)PO BOX 1093 GT QUEENSGATE HOUSE SGRAND CAYMANCJCJ
CAVALRY CLO IV LTD
INVESTMENT ACTIVITIESN/ACYes (1)PO BOX 1093 GT QUEENSGATE HOUSE SGRAND CAYMANCJCJ
GMO GLOBAL BOND INVESTMENT FUND
OTHER FINANCIAL INVESTMENT ACTIVITIESN/AYes (1)78 SIR JOHN ROGERSONS QUAYDUBLIN 2EIEI
HEALTH TRADITION HEALTH PLAN
1808 EAST MAIN STREETONALASKAWI54650391545987MEDICAL SERVICES COMPANYWIN/ACYes (1)
LOBSS NETWORK SUPPORT 2002 INC
200 FIRST STREET SWROCHESTERMN55905481276150ADMINISTRATIVE SERVICESMNN/ACYes (1)
MAYO CLINIC GBS MAURITIUS
HEALTHCARE MANAGEMENTN/ACYes (1)2ND FLOOR EBENE MEWS 57EBENE CYBERCITYMPMP
MAYO CLINIC SUPPORT SERVICES TEXAS
200 FIRST STREET SWROCHESTERMN55905471751102HEALTH SERVICESTXN/ACYes (1)
MAYO HOLDING COMPANY
200 FIRST STREET SWROCHESTERMN55905411578020HOLDING COMPANYMNN/ACYes (1)
MAYO INSURANCE COMPANY LTD
200 FIRST STREET SWROCHESTERMN55905SELF INSURANCE POOLN/ACYes (1)CJ
MCHS--DECORAH CLINIC PHYSICIANS
907 MONTGOMERY STREETDECORAHIA52101411711329PATIENT CARE - CLINICIAN/ACYes (1)
MCHS--PHARMACY & HOME MEDICAL INC
1221 WHIPPLE STREETEAU CLAIREWI54703391528920PHARMACY SERVICESWIN/ACYes (1)
MMSI INC
200 FIRST STREET SWROCHESTERMN55905411547003THIRD PARTY ADMINISTRATION SERVICESMNN/ACYes (1)
RESOUNDANT INC
221 1ST AVE SW SUITE 202ROCHESTERMN55902461661978MANUFACTURING MEDICAL DEVICE COMPONENTMNN/ACYes (1)
ROCHESTER AIRPORT COMPANY
200 FIRST STREET SWROCHESTERMN55905410506870AIRPORT MANAGEMENTMNN/ACYes (1)
SUPERBLOCK 3 PROPERTY OWNERS ASSOCIATION
13400 E SHEA BLVDSCOTTSDALEAZ85259860870505COMMERCIAL PROPERTY OWNERS ASSOCIATIONAZN/ACYes (1)
THE STABILE BUILDING OWNERS' ASSOCIATION
200 FIRST STREET SWROCHESTERMN55905208994499COMMERCIAL PROPERTY OWNERS ASSOCIATIONMNN/ACYes (1)
CHARITABLE LEAD TRUST
CHARITABLE TRUSTCAN/ATYes (1)
PERPETUAL TRUST
CHARITABLE TRUSTNDN/ATYes (1)
PERPETUAL TRUST
CHARITABLE TRUSTAZN/ATYes (1)
PERPETUAL TRUST
CHARITABLE TRUSTLAN/ATYes (1)
PERPETUAL TRUST (2)
CHARITABLE TRUSTMAN/ATYes (1)
PERPETUAL TRUST
CHARITABLE TRUSTMON/ATYes (1)
CHARITABLE REMAINDER TRUST
CHARITABLE TRUSTAZN/ATYes (1)
CHARITABLE REMAINDER TRUST
CHARITABLE TRUSTCON/ATYes (1)
CHARITABLE REMAINDER TRUST (8)
CHARITABLE TRUSTFLN/ATYes (1)
CHARITABLE REMAINDER TRUST
CHARITABLE TRUSTLAN/ATYes (1)
CHARITABLE REMAINDER TRUST
CHARITABLE TRUSTMAN/ATYes (1)
CHARITABLE REMAINDER TRUST (77)
CHARITABLE TRUSTMNN/ATYes (1)
CHARITABLE REMAINDER TRUST (2)
CHARITABLE TRUSTNCN/ATYes (1)
CHARITABLE REMAINDER TRUST
CHARITABLE TRUSTTXN/ATYes (1)
CHARITABLE REMAINDER TRUST
CHARITABLE TRUSTCON/ATYes (1)
CHARITABLE REMAINDER TRUST
CHARITABLE TRUSTILN/ATYes (1)
CHARITABLE REMAINDER TRUST
CHARITABLE TRUSTMIN/ATYes (1)
CHARITABLE REMAINDER TRUST (64)
CHARITABLE TRUSTMNN/ATYes (1)
CHARITABLE REMAINDER TRUST (7)
CHARITABLE TRUSTMNN/ATYes (1)
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (1)TransferToOtherOrgInd
Transfer From Other OrgYes (1)TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (6 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH
P$23,338,260GAAP
MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH
S$58,899GAAP
MCHS-ALBERT LEA AND AUSTIN
M$1,418,244GAAP
MCHS-ALBERT LEA AND AUSTIN
P$3,103,784GAAP
MCHS-ALBERT LEA AND AUSTIN
R$1,975,191GAAP
MMSI INC
S$2,441,685GAAP

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